Functional Neurology[JOURNAL]
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200 papers
The urgent need for a systems biology approach to neurology.
D'Angelo E
Funct Neurol · 2014 · PMID 25764251
Abstract loading — click title to view on PubMed.
Chronobiological correlates of headache: three decades on.
Viana M, Nappi G
Funct Neurol · 2014 · PMID 25473743
In 1983 an international symposium entitled "Chronobiological Correlates of Headache" was held in Capri. This meeting provided an opportunity to debate new and stimulating aspects of headache, in particular the temporal...
In 1983 an international symposium entitled "Chronobiological Correlates of Headache" was held in Capri. This meeting provided an opportunity to debate new and stimulating aspects of headache, in particular the temporal pattern of headache and the periodicity of the underlying biological and environmental phenomena. Giuseppe Nappi presented his dyschronic hypothesis of primary headaches, which was based on the observation that these conditions involve not only a dysfunction in pain control systems, but also a vulnerability of the rhythmic physiological organization of the central nervous system. He suggested that the hypothalamus played a key role in this vulnerability. Several decades on, thanks to the advent of new technologies (functional neuroimaging and neurophysiological studies), this hypothesis has been supported by scientific data.
Cortical spreading depression: origins and paths as inferred from the sequence of events during migraine aura.
Petrusic I, Zidverc-Trajkovic J
Funct Neurol · 2014 · PMID 25473742
Patients with migraine with aura often experience a variety of visual and somatosensory phenomena and disturbances of higher cortical functions. Analysis of these alterations may provide important information about the i...
Patients with migraine with aura often experience a variety of visual and somatosensory phenomena and disturbances of higher cortical functions. Analysis of these alterations may provide important information about the involvement of different cortical regions in cortical spreading depression (CSD). We report five cases of migraineurs who experience unusually abundant clinical phenomena during auras. These patients were selected from a cohort of migraine with aura patients who were interviewed, using a specially designed questionnaire, to evaluate the presence of higher cortical dysfunctions. On the basis of the aura symptoms they reported, we attempted to infer the origin and the possible paths of CSD in each patient. According to their reported symptoms, CSD could begin in the primary visual cortex, in the primary somatosensory cortex or simultaneously in both, and propagate to the posterior parietal cortex, the temporal lobe and Broca's area. We believe that clinical descriptions of aura could play an important role in further investigations of the pathophysiology of migraine.
Long-lasting coma.
Bagnato S, Boccagni C, Sant'Angelo A … +4 more , Fingelkurts AA, Fingelkurts AA, Gagliardo C, Galardi G
Funct Neurol · 2014 · PMID 25473741
In this report, we describe the case of a patient who has remained in a comatose state for more than one year after a traumatic and hypoxic brain injury. This state, which we refer to as long-lasting coma (LLC), may be a...
In this report, we describe the case of a patient who has remained in a comatose state for more than one year after a traumatic and hypoxic brain injury. This state, which we refer to as long-lasting coma (LLC), may be a disorder of consciousness with significantly different features from those of conventional coma, the vegetative state, or brain death. On the basis of clinical, neurophysiological and neuroimaging data, we hypothesize that a multilevel involvement of the ascending reticular activating system is required in LLC. This description may be useful for the identification of other patients suffering from this severe disorder of consciousness, which raises important ethical issues.
Knowledge of electromyography (EMG) in patients undergoing EMG examinations.
Mondelli M, Aretini A, Greco G
Funct Neurol · 2014 · PMID 25473740
The aim of this study was to evaluate knowledge of electromyography (EMG) in patients undergoing the procedure. In one year, 1,586 consecutive patients (mean age 56 years; 58.8% women) were admitted to two EMG labs to un...
The aim of this study was to evaluate knowledge of electromyography (EMG) in patients undergoing the procedure. In one year, 1,586 consecutive patients (mean age 56 years; 58.8% women) were admitted to two EMG labs to undergo EMG for the first time. The patients found to be "informed" about the how an EMG examination is performed and about the purpose of EMG numbered 448 (28.2%), while those found to be "informed" only about the manner of its execution or only about its purpose numbered 161 (10.2%) and 151 (9.5%), respectively. The remaining 826 (52.1%) patients had either no information, or the information they had was very poor or incorrect (this was particularly true if they had been consulting websites). Being "informed" was associated with level of education (high), type of referring physician (specialist) and with an appropriate referral diagnosis specified in the EMG request. The quality of patient information on EMG was found to be very poor and could be improved. Physicians referring patients for EMG examinations, especially general practitioners, should assume primary responsibility for patient education and counseling in this field.
Anodal transcranial direct current stimulation of the right dorsolateral prefrontal cortex enhances memory-guided responses in a visuospatial working memory task.
Giglia G, Brighina F, Rizzo S … +6 more , Puma A, Indovino S, Maccora S, Baschi R, Cosentino G, Fierro B
Funct Neurol · 2014 · PMID 25473739
Several studies have shown that transcranial direct current stimulation (tDCS) is able to enhance performances on verbal and visual working memory (WM) tasks. Available evidence points to the right dorsolateral prefronta...
Several studies have shown that transcranial direct current stimulation (tDCS) is able to enhance performances on verbal and visual working memory (WM) tasks. Available evidence points to the right dorsolateral prefrontal cortex (DLPFC) as a critical area in visual WM, but to date direct comparisons of the effects obtained by stimulating the left versus the right DLPFC in the same subject are lacking. Our aim was to determine whether tDCS over the right DLPFC can differently affect performance as compared with left DLPFC stimulation. Ten healthy subjects performed a memory-guided visuospatial task in three conditions: baseline, during anodal stimulation applied over the right and during anodal stimulation applied over the left DLPFC. All the subjects also underwent a sham stimulation as control. Our results show that only active stimulation over the right DLPFC is able to increase performance when compared to the other conditions. Our findings confirm the crucial role played by the right DLPFC in spatial WM tasks.
Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years.
Dalla Toffola E, Pavese C, Cecini M … +6 more , Petrucci L, Ricotti S, Bejor M, Salimbeni G, Biglioli F, Klersy C
Funct Neurol · 2014 · PMID 25473738
Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis (House-Brackmann grade VI) treated with hypoglossal-facial nerve (XII-VII) anastomosis and a long-term rehabilitation pro...
Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis (House-Brackmann grade VI) treated with hypoglossal-facial nerve (XII-VII) anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback. Reinnervation after XII-VII anastomosis occurred in 29 patients, on average 5.4 months after surgery. Three years after the anastomosis, 23.3% of patients had grade II, 53.3% grade III, 20% grade IV and 3.3% grade VI ratings on the House-Brackmann scale. Time to reinnervation was associated with the final House-Brackmann grade. Our study demonstrates that patients undergoing XIIVII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The recovery continues for at Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable.
Motor conduction measurement in myelopathy hand.
Shibuya R, Wada E, Iwasaki M … +2 more , Yonenobu K, Yoshikawa H
Funct Neurol · 2014 · PMID 25473737
We studied the relationship between intramedullary high signal intensity (IMHSI) on T2-weighted magnetic resonance images and motor conduction in the spinal cords of cervical spondylotic myelopathy (CSM) patients. There...
We studied the relationship between intramedullary high signal intensity (IMHSI) on T2-weighted magnetic resonance images and motor conduction in the spinal cords of cervical spondylotic myelopathy (CSM) patients. There was no significant difference between the biceps or triceps central motor conduction times (CMCTs) of the patients who did and did not exhibit IMHSI, whereas the abductor pollicis brevis CMCT was significantly longer in the patients who exhibited IMHSI (p<0.05) than in those who did not. The CMCT of the abductor pollicis brevis is sensitive to the degree of damage in the cervical spinal cord. Hand dysfunction is a characteristic of CSM regardless of the cervical level affected by the condition. The motor fibers innervating the intrinsic muscles of the hand in the long tract of the cervical spinal cord are more sensitive than other motor fibers. For this reason, we consider that myelopathy hand is a characteristic impairment of CSM. Transcranial magnetic stimulation of the hand motor cortex is useful for the evaluation of cervical myelopathy.
Health-related quality of life after traumatic brain injury: Italian validation of the QOLIBRI.
Giustini M, Longo E, Azicnuda E … +7 more , Silvestro D, D'Ippolito M, Rigon J, Cedri C, Bivona U, Barba C, Formisano R
Funct Neurol · 2014 · PMID 25473736
The QOLIBRI (Quality of Life after Brain Injury) is a new international health-related quality of life (HRQoL) instrument developed for assessing the consequences of traumatic brain injury (TBI). We report the results of...
The QOLIBRI (Quality of Life after Brain Injury) is a new international health-related quality of life (HRQoL) instrument developed for assessing the consequences of traumatic brain injury (TBI). We report the results of the Italian validation of the QOLIBRI. A total of 147 participants with TBI who had previously been discharged from the Santa Lucia Foundation rehabilitation hospital were recruited to investigate the concurrent validity of the Italian version of the QOLIBRI and to compare this instrument with several functional and cognitive-behavioral scales, taking into account various clinical parameters. The QOLIBRI met the standard criteria for internal consistency, homogeneity and test-retest reliability. The results suggest that it is very sensitive in relation to outcome as measured by the Extended Glasgow Outcome Scale (GOS-E) and other instruments for functional assessment of disability, emotions and subjective health status, including the Hospital Anxiety and Depression Scale and the Short-Form 36. The QOLIBRI avoids some of the limitations of traditional scales for quantifying residual functional capaci-Health-related quality of life after traumatic brain injury: Italian validation of the QOLIBRI, such as the Glasgow Outcome Scale and the GOS-E, and may contribute to the achievement of better quality-controlled care, medical decision-making, rehabilitation planning, and measurement of well-being and HRQoL from the patient's perspective. However, a longitudinal study is needed to assess the responsiveness of the QOLIBRI to changes over time.
High prevalence of incomplete right bundle branch block in facioscapulohumeral muscular dystrophy without cardiac symptoms.
van Dijk GP, van der Kooi E, Behin A … +6 more , Smeets J, Timmermans J, van der Maarel S, Padberg G, Voermans N, van Engelen B
Funct Neurol · 2014 · PMID 25473735
The exact prevalence and nature of cardiac involvement in facioscapulohumeral muscular dystrophy (FSHD) is unknown. Nevertheless, the current opinion is that symptomatic cardiac disease is rare. We performed a cardiac sc...
The exact prevalence and nature of cardiac involvement in facioscapulohumeral muscular dystrophy (FSHD) is unknown. Nevertheless, the current opinion is that symptomatic cardiac disease is rare. We performed a cardiac screening [electrocardiogram (ECG) and echocardiography in the event of ECG abnormalities] in 75 genetically confirmed, ambulant FSHD patients without cardiac symptoms, with an eight-year follow-up of 57 patients, and compared the findings with results of previously performed cardiac screenings in the normal population. Baseline ECG demonstrated incomplete right bundle branch block (RBBB) in 33%, complete RBBB in 4%, and other minor abnormalities in 16%. Echocardiography showed no abnormalities. No significant changes were found after eight years of follow-up. Comparison with ECG abnormalities in the normal population showed a higher prevalence of incomplete RBBB (9.7 times higher) and of complete RBBB (4.8 times higher) in FSHD patients. This study in cardiac asymptomatic FSHD patients shows i) increased prevalence of incomplete RBBB in the absence of cardiomyopathy; ii) no progression of these abnormalities during eight years of follow-up. We conclude that FSHD patients without cardiac complaints do not need specific cardiac screening or surveillance. Furthermore, the increased prevalence of incomplete RBBB in the absence of cardiomyopathy suggests a selective involvement of the His-Purkinje system in FSHD.
Serious games for screening pre-dementia conditions: from virtuality to reality? A pilot project.
Zucchella C, Sinforiani E, Tassorelli C … +10 more , Cavallini E, Tost-Pardell D, Grau S, Pazzi S, Puricelli S, Bernini S, Bottiroli S, Vecchi T, Sandrini G, Nappi G
Funct Neurol · 2014 · PMID 25473734
Conventional cognitive assessment is based on a pencil-and-paper neuropsychological evaluation, which is time consuming, expensive and requires the involvement of several professionals. Information and communication tech...
Conventional cognitive assessment is based on a pencil-and-paper neuropsychological evaluation, which is time consuming, expensive and requires the involvement of several professionals. Information and communication technology could be exploited to allow the development of tools that are easy to use, reduce the amount of data processing, and provide controllable test conditions. Serious games (SGs) have the potential to be new and effective tools in the management and treatment of cognitive impairments Serious games for screening pre-dementia conditions: from virtuality to reality? A pilot project in the elderly. Moreover, by adopting SGs in 3D virtual reality settings, cognitive functions might be evaluated using tasks that simulate daily activities, increasing the "ecological validity" of the assessment. In this commentary we report our experience in the creation of the Smart Aging platform, a 3D SGand virtual environment-based platform for the early identification and characterization of mild cognitive impairment.
Migraine in men: fact sheet. A publication to mark European Migraine Day of Action 2014.
Rossi P, Nappi G
Funct Neurol · 2014 · PMID 25473733
Abstract loading — click title to view on PubMed.
Can robot-assisted movement training (Lokomat) improve functional recovery and psychological well-being in chronic stroke? Promising findings from a case study.
Calabrò RS, Reitano S, Leo A … +3 more , De Luca R, Melegari C, Bramanti P
Funct Neurol · 2014 · PMID 25306125
The Lokomat is a robotic device that has been widely used for gait rehabilitation in several neurological disorders, with a positive effect also in the chronic phase. We describe the case of a 54-yearold female with post...
The Lokomat is a robotic device that has been widely used for gait rehabilitation in several neurological disorders, with a positive effect also in the chronic phase. We describe the case of a 54-yearold female with post-stroke moderate-to-severe chronic hemiplegia, whose force, gait and balance significantly improved after intensive training with Lokomat Pro. We also noted a positive impact of Lokomat on mood and coping styles. This may be partly related to the task-oriented exercises with computerized visual feedback, which in turn can be considered an important tool for increasing patients' motor output, involvement and motivation during gait training. Augmented feedback during robot-assisted gait appears to be a promising way of facilitating gait and physical function, but also of improving psychological and cognitive status.
Tako-tsubo syndrome as a consequence and cause of stroke.
Bersano A, Melchiorre P, Moschwitis G … +5 more , Tavarini F, Cereda C, Micieli G, Parati E, Bassetti C
Funct Neurol · 2014 · PMID 25306124
Since tako-tsubo syndrome (TS) frequently appears soon after stroke (usually stroke involving the insular cortex), it is believed to be a consequence rather than a cause of stroke. Herein, we describe a 70-year-old woman...
Since tako-tsubo syndrome (TS) frequently appears soon after stroke (usually stroke involving the insular cortex), it is believed to be a consequence rather than a cause of stroke. Herein, we describe a 70-year-old woman presenting with a left middle cerebral artery stroke (involving the insular cortex) who developed a further contralateral ischemic stroke with concomitant detection of a transient intracardiac mural thrombus attributable to TS. It can reasonably be maintained that that in our patient insular stroke triggered the TS, which in turn became the embolic cause of a further stroke. Given the association between TS and the risk of embolic stroke, congestive heart failure and sudden death, stroke physicians need to promptly detect and appropriately manage this condition.
Biofeedback rehabilitation of posture and weightbearing distribution in stroke: a center of foot pressure analysis.
De Nunzio A, Zucchella C, Spicciato F … +4 more , Tortola P, Vecchione C, Pierelli F, Bartolo M
Funct Neurol · 2014 · PMID 25306123
Weight bearing on the paretic lower extremity and transfer of weight from one lower extremity to the other are important goals of stroke rehabilitation. Improvements in these limb loading and weight transfer abilities ha...
Weight bearing on the paretic lower extremity and transfer of weight from one lower extremity to the other are important goals of stroke rehabilitation. Improvements in these limb loading and weight transfer abilities have been shown to relate to improved performance of many functional activities. Unfortunately, valid and practical clinical measures of paretic lower extremity loading and weight transfer have not been identified. The purpose of this study was to quantitatively assess, through center of foot pressure (CoP) analysis of quiet upright stance control, recovery of paretic limb loading as a measure of weight transfer in early stroke subjects, testing the effectiveness of a targeted rehabilitation intervention based on audiovisual biofeedback. Thirty-seven adults with lower extremity motor impairment following unilateral, non-cerebellar stroke, were Biofeedback rehabilitation of posture and weightbearing distribution in stroke: a center of foot pressure analysis tested twice, at an interval of at least one month post stroke and following rehabilitation intervention aimed at correcting their asymmetrical weight bearing. The intervention was performed with (Study Group, SG) or without (Control Group, CG) a postural audio-visual biofeedback approach. Indices of postural stability and of balance control asymmetry were estimated by acquiring the movements of the CoP during quiet upright stance condition with or without visual input (eyes open, EO and eyes closed, EC). Clinical scales were also administered. Both the CG and the SG subjects showed improved control in upright stance posture as documented by significant improvements in the scale scores and indices of stability during both the EO and the EC condition. Only the SG showed a significantly reduced CoP index of asymmetry. The CoP index of asymmetry, correlating with clinical motor scales, is a valid measure of paretic limb loading during stroke recovery. Postural audio-visual biofeedback represented the more effective approach for reducing weight loading asymmetry of the lower limbs in stroke.
Auditory cortical activation and plasticity after cochlear implantation measured by PET using fluorodeoxyglucose.
Łukaszewicz-Moszyńska Z, Lachowska M, Niemczyk K
Funct Neurol · 2014 · PMID 25306122
The purpose of this study was to evaluate possible relationships between duration of cochlear implant use and results of positron emission tomography (PET) measurements in the temporal lobes performed while subjects list...
The purpose of this study was to evaluate possible relationships between duration of cochlear implant use and results of positron emission tomography (PET) measurements in the temporal lobes performed while subjects listened to speech stimuli. Other aspects investigated were whether implantation side impacts significantly on cortical representations of functions related to understanding speech (ipsi- or contralateral to the implanted side) and whether any correlation exists between cortical activation and speech therapy results. Objective cortical responses to acoustic stimulation were measured, using PET, in nine cochlear implant patients (age range: 15 to 50 years). All the patients suffered from bilateral deafness, were right-handed, and had no additional neurological deficits. They underwent PET imaging three times: immediately after the first fitting of the speech processor (activation of the cochlear implant), and one and two years later. A tendency towards increasing levels of activation in areas of the primary and secondary auditory cortex on the left side of the brain was observed. There was no clear effect of the side of implantation (left or right) on the degree of cortical activation in the temporal lobe. However, the PET results showed a correlation between degree of cortical activation and speech therapy results.
Dispositional optimism, depression, disability and quality of life in Parkinson's disease.
Gison A, Dall'Armi V, Donati V … +2 more , Rizza F, Giaquinto S
Funct Neurol · 2014 · PMID 25306121
Very little research on dispositional optimism (DO) has been carried out in the field of Parkinson's disease (PD). The present cross-sectional study, focusing on this personality trait, was performed with two main aims:...
Very little research on dispositional optimism (DO) has been carried out in the field of Parkinson's disease (PD). The present cross-sectional study, focusing on this personality trait, was performed with two main aims: i) to compare DO between patients with PD and a control group (CG); ii) to perform, in the PD group, a regression analysis including health-related variables, such as depression, anxiety, quality of life (QoL) and activities of daily living. Seventy PD participants and 70 healthy volunteers were enrolled in the study. The Mann-Whitney test was used to compare life orientation between the PD and CG groups. In the PD group, Pearson's correlation analysis was used to investigate the relationship between the measures of DO and the other variables. Means of log-linear regression were also used. Mean ratios adjusted for sex, age, education, and severity of disease were estimated, with relative 95% confidence intervals and p-values. The main results were as follows: i) no significant difference in DO was found between the PD participants and the CG; ii) DO was positively associated with QoL and emotional distress and inversely correlated with the Unified Parkinson's Disease Rating Scale; iii) DO was not correlated with disability. In conclusion, high DO predicts a satisfactory quality of life, low emotional distress and reduced disease severity in PD.
Driving habits in patients with dementia: a report from Alzheimer's disease assessment units in northern Italy.
Mauri M, Sinforiani E, Cuzzoni MG … +2 more , Bono G, Zucchella C
Funct Neurol · 2014 · PMID 25306120
The aim of this study was to characterize the driving behavior of a sample of patients with dementia. Demographic and clinical characteristics and parameters considered to be the most significant predictors of driving ab...
The aim of this study was to characterize the driving behavior of a sample of patients with dementia. Demographic and clinical characteristics and parameters considered to be the most significant predictors of driving ability were collected. Of the total 198 patients enrolled, 172 were still driving. Many subjects (30-65%) were found to have modified their driving habits (reducing driving time and mileage, avoiding driving at night and during rush hours, sticking to familiar routes). The patients' own rating of their driving ability was significantly higher than their caregivers' rating (51% versus 29%). Crash history was not a significant variable. The patients' restriction of their driving increased significantly (p<0.01) with age and increasing worsening of cognitive, functional and behavioral variables. In the absence of a gold standard for determining fitness to drive, the patients' driving habits were self-regulated and, in particular, regulated by their caregivers. Age and degree of dementia can be considered among the best predictors of driving safety.
"Masters and servants" in parkinsonian gait: a three-dimensional analysis of biomechanical changes sensitive to disease progression.
Albani G, Cimolin V, Fasano A … +3 more , Trotti C, Galli M, Mauro A
Funct Neurol · 2014 · PMID 25306119
Gait disorder is a very frequent and disabling symptom in Parkinson's disease (PD). The aim of this study was to identify the main kinetic and kinematic features of PD gait according to different disease stages: early (E...
Gait disorder is a very frequent and disabling symptom in Parkinson's disease (PD). The aim of this study was to identify the main kinetic and kinematic features of PD gait according to different disease stages: early (Early Group), intermediate without freezing (Non-Freezers) and intermediate with freezing (Freezers). Kinematic data showed a distal to proximal progression of impairment from the early to the intermediate with freezing stage. The Early Group showed more accentuated ankle dorsiflexion during stance than the other PD subgroups; the Freezers showed a more flexed hip position at initial contact and a reduced range of motion (ROM) during stance compared with the other patients. The individuals in the intermediate stage (with or without freezing) displayed limited knee ROM. Distal to proximal progression of lower limb impairment in PD might be an expression of a rostral to caudal degeneration of locomotor control centers. Evaluation of the relationship between gait features "Masters and servants" in parkinsonian gait: a three-dimensional analysis of biomechanical changes sensitive to disease progression and disease progression may promote the development of tailored rehabilitation programs.
Altered information processing in children with focal epilepsies with and without intellectual disability.
Japaridze N, Schark M, von-Ondarza G … +5 more , Boor R, Muhle H, Gerber WD, Stephani U, Siniatchkin M
Funct Neurol · 2014 · PMID 25306118
The aim of this exploratory study was to investigate the relationship between focal interictal epileptiform discharges (IEDs), intellectual disability and cortical information processing in children with partial epilepsy...
The aim of this exploratory study was to investigate the relationship between focal interictal epileptiform discharges (IEDs), intellectual disability and cortical information processing in children with partial epilepsy. Two groups of patients--Group 1 (n = 9 patients) with focal IEDs and normal IQ and Group 2 (n = 10 patients) with focal IEDs and intellectual disability--were compared with 14 healthy control participants. A computerized choice reaction time task (go/no-go paradigm) was performed and event-related potentials (ERPs) were recorded. When an IED occurred during the period between the presentation of the stimulus and the response, the response was defined as a response with IED. Omission errors, commission errors and reaction time were evaluated in temporal relationship to IEDs. The Group 1 patients did not differ from the healthy children in neurophysiological functions and ERP amplitudes. The Group 2 children showed inferior Altered information processing in children with focal epilepsies with and without intellectual disability performances in verbal learning and memory, cognitive flexibility and selective attention, and were characterized by low ERP amplitudes compared with the epilepsy patients with normal IQ and the healthy children. We were not able to identify any significant relationship between IEDs and cognitive functions in either group of patients. Our findings suggest that the impact of IEDs on the overall intellectual abilities of epilepsy patients may not be as significant as previously thought. Moreover, it is likely that abnormalities in cognitive information processing as revealed by lower ERP amplitudes, occurrence of IEDs, and intellectual disabilities may represent common abnormal processes and may not be causally related to each other.
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